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Background & Objective: Labor pain management is one of the most important procedures of midwifery cares. Acupressure, a non-pharmacological method of labor pain relief, is an available, easy to use, inexpensive, and without side effect method of pain relief. The purpose of this study was to compare the effects of LI-4 acupressure on labor pain in women during first stage of labor.

Methods & Materials: A single blind randomized clinical trial study was carried out on 83 primipara women. The inclusion criteria were singleton pregnancy in 38-42 weeks of gestation, cephalic presentation, and spontaneous uterine contractions. Participants were divided into three groups including acupressure group, touch group, and the usual care (control group). The intensity of labor pain was measured using visual analog scale with the rating from 0-100 mm immediately, 30 minutes, and one hour after the intervention during the first stage of labor. Data were analyzed using statistical tests of ANOVA, Chi-square, and Exact chi-square.

Results: Findings indicated that acupressure group had lower labor pain in the active phase of the first stage of labor immediately after intervention than the other groups (P=0.026).

Conclusion: The results of this study suggested that LI4 acupressure reduced the intensity of labor pain in the first stage of labor without any side effects to mother and infant. This procedure can be used as a simple, safe and inexpensive method to relief labor pain.

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Background & Aim: The aim of this study was to investigate the relationship between nurses&apos knowledge about pain and satisfaction from pain relieving procedures among postoperative CABG patients in selected Tehran medical university hospitals.

Methods & Materials: In this cross-sectional study, 100 nurses were recruited from the ICU Open heart. Also, 200 patients were selected from whom underwent CABG in 24 hours after surgery and were extubated using a simple random sampling method. Data were gathered using two questionnaires including 17 question about demographic characteristics of patients and their satisfaction, and 36 questions about demographic characteristics and nurses&apos knowledge about pain and pain control after the CABG. Data were analyzed using descriptive and inferential methods using SPSS-11.5.

Results: There was not significant relationship between the nurses&apos pain knowledge and the patients&apos satisfaction. However, there were a significant relationship between the knowledge of the nurses about pain control after the CABG and the patients satisfactions (r=0.209, P=0.037).

Conclusion: According to the findings of the study, there were some significant relationships between the nurses demographic and pain knowledge with the pain control after the CABG. There was also significant relationship between patients&apos satisfaction and some of them demographic characteristics.

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Background & Aim: Pain can detrimentally affect physical functioning, psychological well-being and social interaction. Various attitudinal factors may be associated with inadequate pain control. Hence, studies should be undertaken to gain a better understanding of association between pain control attitudes and use of analgesics and cancer pain intensity. This study aimed to determine relationship between pain control attitudes and use of analgesics and pain intensity in cancer patients with pain.

Methods & Materials: A descriptive cross-sectional study was conducted with 200 cancer patients who underwent chemotherapy or radiotherapy and experienced pain in previous 24 hours. The pain control attitudes, use of analgesics, worrisome about using analgesics and physical and psychological impacts of pain were measured using questionnaires. The cancer pain intensity was measured using the visual analogue scale. Validity and reliability of the instruments were evaluated. Data were analyzed using independent t-test and ANOVA.

Results: About 58% of patients agreed that they would wait before asking for help. Beside, the findings indicated that willing to tolerate pain and perceived control over pain were associated with the time and frequency of taking analgesic and pain intensity in previous 24 hours and last week. Also concerns about addiction to pain-relieving medications were related to the analgesic type and pain intensity within last week (P=0.03), and fear of injection was related to analgesic use and pain intensity within last week (P<0.001).

Conclusion: Many cancer patients had attitudes which could interfere with pain relieving. Suggestions are made for developing patient education programs, accessing effective cancer pain controls and decision making for cancer pain relief.

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Background & Aim: Shoulder pain is a consequence of hemiplegia among patients with stroke. It makes patient to be dependent to others in their daily living activities. This study aimed to determine the effect of the slow stroke back massage (SSBM) on shoulder pain and hand function among patients with stroke.

Methods & Materials: In this semi-experimental study, 34 patients were recruited among from 70 patients who reffered to rehabilitation center in 2010, according to the inclusion criteria. Participants were randomly allocated into two groups of control and experiment. In the intervention group, the SSBM was implemented for 10 minutes through seven consecutive sessions. Shoulder pain and hand function were measured using the visual pain scale (Visual Analog Scale), and the researcher-made "affected hand function in ADL" instrument, respectively. The measurement was done before and 24 hours after the last session of the intervention. Data were analyzed using descriptive and inferential statistical tests (independent t-test and paired t-test).

Results: At baseline, the mean scores of shoulder pain were 8.4 in both experimental and control groups (P=0.999). After the intervention, the mean scores of shoulder pain were 1.13 and 8.40 in experimental and control groups, respectively (P<0.001). At baseline, the mean scores of hand function were 7.46 and 8.93 in the experimental and control groups, respectively (P=0.752). After the intervention, the mean scores of hand function reached 9.13 and 8.6 in the experimental and control groups, respectively (P=0.918).

Conclusion: According to the results of the study, applying the SSBM as a treatment procedure and care plan by health care providers can be considered as an effective intervention to prevent or reduce shoulder pain and consequently to improve motor function of affected hand in patients with hemiplegia after stroke.

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Background & Aim: Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce short- and long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling.

Methods & Materials: This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS.

Results: Results showed significant difference in heart rate between the experiment and control groups during needle exit (P=0.022). There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling (P=0.005).

Conclusion: Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.

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Background & Aim: The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention.

Methods & Materials: In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses&apos performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test.

Results: Findings showed that the CPOT could not lead to improved nurses&apos function in relation to documentation of pain in the patients records (P=0.209) and recording palliative measures related to pain (P=0.117). However, there were significant statistical differences between nurses&apos function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention.

Conclusion: The critical-care pain observation tool can increase nurses&apos sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures.

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Background & Aim: Pain is an unpleasant experience related to potential or actual tissue damage. Distraction is an effective technique to control pain. This study aimed to examine the effect of pressing a small soft ball during intravenous catheter insertion on pain related behavioral responses of children.

Methods & Materials: A randomized clinical trial study was conducted in surgical ward of the Qods hospital in Qazvin, Iran in 2010. Sixty children aged 4-6 were selected through a simple randomized sampling method. The children were allocated into two equal intervention and control groups. Data were collected using the FLACC scale. In the intervention group, children were asked to press a soft ball during IV catheter insertion. The researcher marked the FLACC during the procedure. In the control group, no distraction was made during the IV catheter placement. The data were analyzed using descriptive statistics, independent-sample t-test, Chi square at P<0.05.

Results: There was no significant difference between the two groups in terms of demographic variables including gender, birth order, race, age and type of disease. In the intervention group, none of the children experienced severe pain during IV catheter insertion and 63.3% of the children had moderate pain. In the control group, 50.0% of children had moderate pain and 23.3% of them experienced severe pain during IV catheter insertion. There was a significant difference in perceived pain between the children of two groups (P<0.001).

Conclusion: Distraction is an effective, non-expensive, and easy-to-access technique to control and reduce pain in children during IV catheter placement. This study showed that distraction through pressing a soft ball was effective in reducing the behavioral responses of pain in children who underwent IV catheter placement.

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  Background & Aim: Patients with end-stage renal disease undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula . Patient comfort with the procedure is therefore of greatest importance for long-term compliance with the treatment and until a successful renal transplant. This study was conducted to determine the effect of rhythmic breathing on pain intensity when the needles are inserted into vascular access for hemodialysis .

  Methods & Materials: This was a quasi -experimental one-group time-series study. Thirty five patients in hemodialysis ward of Hamadan Besat hospital entered into the study via convenient sampling method. In this study, pain intensity during the insertion of hemodialysis vascular needles was measured in six sessions through two methods of routine intervention and rhythmic breathing. The data were collected using visual analog scale. Paired t-test was used to determine pain intensity mean difference between the two conditions . 

  Results: Overall, the results showed that the mean pain intensities were 5.45±1.15 and 2.19±0.92 in two conditions including routine intervention and rhythmic breathing , respectively. Paired t-test showed a significant difference between the routine intervention and rhythmic breathing (P<0.001) .

  Conclusion: These findings showed that rhythmic breathing was effective in reducing pain when the needles were inserted into the vascular access. Therefore, it is recommended to use rhythmic breathing as a simple and non-expensive method to reduce pain in patients before insertion of hemodialysis vascular needles .

  

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  Background & Aim: Patients with multiple sclerosis suffer from permanent pain. It is being increased to apply relaxation therapy to decrease patients' pain. The progressive muscle relaxation make the muscles feel more relaxed. The aim of this study was to assess the effect of progressive muscle relaxation on pain among patients with multiple sclerosis .

  Methods & Materials: A randomized controlled trial was carried out among 70 patients with multiple sclerosis selected from Hamadan Multiple Sclerosis Society patients. Inclusion criteria involved diagnosed with multiple sclerosis, 20-65 year old patients, having ability to do daily 20-minute exercises, feeling pain, having an EDSS score equal or less than 4.5. Patients were randomly divided into two groups of control and intervention. Patients' pain was measured using the VAS scale in the two groups at baseline. The relaxation training was implemented among intervention group patients and was repeated three times a week for four weeks. Each session lasted 40 minutes and the patients continued doing exercise at home for the other eight weeks. The control group patients were observed routinely. Patients' pain was measured eight weeks later in both groups. Data were analyzed using the paired independent t-test in the SPSS-16 .

  Results: Muscle relaxation had significant effect on pain among patients with multiple sclerosis (P<0.05). The mean of pain severity decreased from 4.60 ± 1.75 to 3.26±1.88 in the intervention group after the intervention. The mean of pain severity remained constant .

  Conclusion: This progressive muscle relaxation can be used for decreasing pain among patients with multiple sclerosis as a non-expensive, safe and simple method .

  

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Background & Aim: Vaccination is the most common painful procedure in childhood. This study aimed to compare the effect of Hugo point massage with and without ice on the injection-related pain of pentavalent vaccine in infants.
Methods & Materials: This study is a blind randomized clinical trial (IRCT2016052127982N1) conducted on 90 healthy, two-month old infants with normal weight, referred to Gonabad Fayazbakhsh health center to inject pentavalent vaccine in 2016. Infants were randomly assigned into three groups including 1) massage on Hugo’s point with ice 2) massage on Hugo’s point without ice and 3) control group. Data collection tool includes demographic information form and infant’s pain measurement tool. Data were analyzed using Chi-square test, Kruskal–Wallis test, analysis of variance and post-hoc Tukey HSD through the SPSS software version 16.
Results: There was no significant difference in pain intensity before vaccination between three groups. After vaccination, mean pain score for the first group was 7.70±1.26, for the second group was 8.03±1.06 and for the third group was 9.23±0.89. Also, crying duration in the first group was 35.03±23.12, in the second group was 40.39±21.62 and in the third group was 61.28±24.00. Both variables in the intervention groups were significantly lower compared to the control group (P<0.001) but there was no significant difference between the two intervention groups (P=0.586 and P=0.654).
Conclusion: Hugo’s point massage with and without ice can reduce the injection-related pain of pentavalent vaccine in infants and be used as a simple non-pharmaceutical method available to control vaccination pain.
 

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Background & Aim: Postoperative pain is one of the clinical challenges for nurses who care for patients. The objective of this review was to evaluate the effect of preoperative education on postoperative pain after elective surgery.
Methods & Materials: A literature search was done on PubMed, CINAHL, Cochrane Library, Web of Science, Scopus and EMBASE to find the articles published in English on clinical trials from January 2012 to June 2018.
Results: Out of 153 studies retrieved, 13 studies (2482 people) were reviewed. Generally, most studies indicated the effectiveness of preoperative education on postoperative pain relief (7 studies, n=1678). In other studies, there was no significant difference between education and the degree of pain reduction in the patient. Also, the results of some studies (n=204) showed that education with empathy could reduce anxiety in half of the cases.
Conclusion: Preoperative education as a complex intervention can reduce postoperative pain. Interactive education with empathy reduces patient’s anxiety and the need for postoperative analgesics. Therefore, training skilled nurses and the providers of such education is suggested for managing pain in patients.
 

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Background & Aim: Childhood vaccination as the most common iatrogenic pain is the main source of pain, anxiety and stress in children and parents, which is often done without pain management. Therefore, given the importance of pain control in children, and the recognition and application of pain control methods by the health team members, this study was conducted to evaluate the effect of ShotBlocker on vaccination pain in 6-month-old infants.
Methods & Materials: In this clinical trial study, 80 infants referred to Mehrshahr health center in Birjand in 2018-2019, were selected using the convenience sampling method based on the study criteria, and then randomly assigned to the control or experimental groups. In the experimental group, 20 seconds before the injection until the end of the injection, pressure was applied to the injection site with a ShotBlocker. The control group only received routine care. The pain status in the two groups was measured using the Pain Behavioral Response Scale (FLACC) 15 seconds after injection, and also the duration of crying from the time of vaccine injection to the end of crying was compared between the two groups. Data was analyzed using descriptive and inferential statistics including Mann-Whitney, t-test, and analysis of covariance at the significance level of less than 0.05.
Results: The study results revealed the mean pain intensity (4.32±0.99), duration of crying (14.4±3.92), and the time of onset of crying (4.05±0.933) were lower in the experimental group than those of in the control group (P<0.001).
Conclusion: Considering that ShotBlocker is effective in reducing pain intensity, the duration of crying and delay in onset of crying, it is recommended to use this simple, safe, and low-cost device to manage pain during vaccine injection.
Clinical trial registry: IRCT20191128045534N1
 

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Background & Aim: Pain during vascular access is an integral part of the life of hemodialysis patients. The aim of this study was to determine the effect of topical ginger on pain following needle insertion into the arteriovenous fistula in hemodialysis patients.
Methods & Materials: In this clinical trial, 100 hemodialysis patients were selected from two hospitals in Shahroud in 2019 and were randomly assigned to intervention or control groups. For the intervention group, ginger ointment was used 20 minutes before needle insertion into the arteriovenous fistula. The control group only received routine care. Patients' pain after needle insertion was assessed using the Numerical Pain Rating Scale. Data was analyzed using the SPSS software version 18 and Chi-square, Fisher, and independent t-tests.
Results: There was a statistically significant difference in the mean and standard deviation of pain scores between the control (8.46±1.26) and intervention (5.08±1.29) groups (P<0.001). While most people in the intervention group experienced moderate pain, most people in the control group had severe pain.
Conclusion: According to the results of the study, the use of topical ginger, which is cheap with almost no side effects, can reduce the severity of pain following needle insertion into the arteriovenous fistula in hemodialysis patients, and its use in hemodialysis wards is recommended.
Clinical trial registry: IRCT20190825044608N1
 

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Background & Aim: Self-care and self-management, as two effective strategies play an effective role in controlling pain and quality of life. Therefore, considering the characteristics and dimensions of these two concepts, this study aimed to compare the effect of self-care education and pain self-management on the nature of pain and quality of life in patients with sickle cell disease.
Methods & Materials: In this clinical trial study, 75 patients with sickle cell disease, referred to the thalassemia clinic of Baqaei hospital 2 in Ahvaz and Shahid Beheshti hospital in Abadan, were selected and randomly divided into three groups of 25 people (self-care, pain self-management and control groups). The two intervention groups (self-care and pain self-management) were divided into groups of five people, and received specific training during four sessions for three months. The nature of pain and quality of life of patients were assessed four times (before the intervention, one month, two months and three months after the intervention) using the McGill Pain Questionnaire and Quality of Life Questionnaire. The SPSS software version 22 was used to analyze the data.
Results: The results showed that pain self-management and self-care programs were effective in improving the quality of life and pain of patients with sickle cell. However, there was no statistically significant difference between the two intervention groups in the nature of pain and quality of life.
Conclusion: Self-care and pain self-management have similar effects on reducing patients’ pain and improving their quality of life.
Clinical trial registry: IRCT20160726029086N5
 

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Background & Aim: Although pain control in patients with burns has improved over recent years, the ineffectiveness of some treatments to reduce pain in this group of patients remains a challenging issue for health care professionals. This systematic review was conducted to investigate nursing interventions in the field of pain relief in burn patients.
Methods & Materials: In this systematic review and meta-analysis, relevant information was searched from databases PubMed, Science Direct, Scopus, Irandoc, SID, and Cochrane library with keywords nursing interventions, pain, burns and their equivalent Persian keywords in the period 2010-2020. To increase the validity and reliability of the study, three people evaluated the quality of the articles separately and Jedad criterion was used to evaluate the articles.
Results: After assessing 181 articles on the databases, 19 articles were systeatically reviewed. Nursing interventions to reduce pain in burn patients included using breathing techniques, new dressings, muscle relaxation, music therapy, transcutaneous electrical nerve stimulation (TENS), electrical brain stimulation, play therapy, aromatherapy, use of Zekr Allah, massage, guided imagery, distraction techniques, and eye movement desensitization. In eight meta-analyses, total mean differences of pain relief score were estimated 1.28 (0.95% CI: 0.78-1.78).
Conclusion: Most nursing interventions reduced pain in burn patients. Easier-to-use pain relief techniques such as muscle relaxation, guided imagery, and spiritual care are emphasized.

 

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Background & Aim: Chest pain is one of the main symptoms of acute coronary syndrome, and sleep disorders are among common problems in these patients. The aim of this study was to determine the effect of Curcuma Longa on chest pain and sleep quality in patients with acute coronary syndrome.
Methods & Materials: This triple-blind clinical trial was conducted on 270 patients in the Coronary Care Unit of Kowsar Hospital in Semnan, with random allocation to three groups (intervention, placebo and control) in 2020-2021. The intervention group received 500 mg of Curcuma Longa tablets and the placebo group received 500 mg of starch, Oisel and lactose tablets at 9 a.m. after breakfast once a day for 3 days. The control group received daily interventions. Chest pain was assessed using the pain assessment tool before the intervention and half an hour after the intervention for 3 consecutive days. Sleep quality was evaluated by the standardized sleep quality questionnaire of Saint Mary's Hospital in the morning of the first day before the intervention and in the morning of the second and third days after the intervention.
Results: There was no significant difference in the average reduction of chest pain intensity from the first to the third day between the groups (P>0.05). But there was a significant difference in the chest pain intensity within the intervention, placebo and control groups (P<0.001), and the average chest pain intensity on the second day compared to the first day of hospitalization decreased in three groups (P<0.001). However, the decrease in chest pain intensity on the third day compared to the second day of hospitalization was not significant in the three groups (P>0.05). The average score of sleep quality before the intervention in the intervention group was higher than that of in the placebo group (P=0.021), but on the second and third days of the intervention, it was lower in the intervention group compared to the placebo (P<0.001) and control groups (P<0.001).
Conclusion: The results showed that Curcuma Longa did not have a significant effect on chest pain in the patients with acute coronary syndrome, but it improved the quality of sleep. Therefore, Curcuma Longa can be used to improve the sleep quality of these patients.
Clinical trial registry: IRCT20110427006318N14

 

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Background & Aim: Reducing pain after surgery, especially cesarean section is one of the most important factors for maternal and infant health. Choosing the way of reducing pain with fewer complications has drawn the attention of researchers. The aim of this study was to compare the effect of Hugo point pressure and auricular seed acupressure on pain after cesarean section.
Methods & Materials: In this clinical trial, 168 pregnant women who were candidates for cesarean section, referred to the educational and medical centers of Rafsanjan University of Medical Sciences in 2020, were selected through purposive sampling and randomly divided into three groups: Hugo point pressure, auriculotherapy, and control. In the Hugo group, massage was applied on the li4 point (between the thumb and forefinger) for 10 minutes. 24 hours later, the intervention was repeated. Before and after the intervention, pain intensity was measured using the Visual Analogue Scale (VAS). In the auriculotherapy group, earrings were placed on the Shenmen point located in the earlobe. Pain was assessed by the VAS 20 minutes after the intervention and 24 hours later. No intervention was performed for the control group and only the researcher was present next to the studied subjects for 10 minutes. Data were analyzed by the SPSS software version 20 using paired t-test and one-way analysis of variance (ANOVA). P<0.05 was considered significant.
Results: The average pain score in the Hugo group was 6.70±1.55 before the intervention and 6.20±1.78 after the intervention (P=0.026). In the auriculotherapy group, the average pain score before the intervention was 5.99±1.75 and after the intervention was 4.66±2.01 (P<0.001). No significant difference was observed in the average score of pain intensity on the first day between the two groups, before the intervention (P=0.062). But the average score of pain intensity on the first day after the intervention was lower in the auriculotherapy group compared to the other two groups (P<0.001). On the second day, there was a significant difference in the average pain score between the three groups after the intervention (P=0.009).
Conclusion: The results of this study showed that both auriculotherapy and the Hugo method are effective for reducing pain after cesarean section; but the continuance of pain reduction after auriculotherapy was more than Hugo point pressure. These methods can be used along with other pharmaceutical methods to reduce pain after cesarean section.
Clinical trial registry: IRCT20131228015965N17

 

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Background & Aim: Considering the use of aromatherapy as a non-pharmacological method of pain control and a scarcity of studies in this area, the aim of the study was to compare the effect of breast milk odor and Rosa damascena aroma on pain and crying due to blood sampling in neonates.
Methods & Materials: In this cross over clinical trial study, 40 neonates hospitalized in the NICU of Ali Ibn Abitalib hospital in Rafsanjan were divided into two groups (breast milk odor and Rosa damascena aroma). In the first step, tree minutes before blood sampling until its completion, cotton soaked in 2 cc of breast milk was placed at a distance of three centimeters from the neonate’s nose. In the next step, cotton soaked with two drops of rose essential oil was used, similar to the method of breast milk. For the second sample, the order of interventions was changed. The pain was calculated with the NIPS instrument and crying with a stopwatch by a person who was blinded to the groups. The data were analyzed by STATA software version 14.
Results: The mean score of pain for two periods in two groups were 3.75±2.33 and 4.30±1.70 respectively, and there was no significant difference between the two groups (P=0.415). The mean score of crying for two periods in two groups were 16.98±16.21 and 15.03±9.99 respectively, and there was no significant difference between the two groups (P=0.650).
Conclusion: The breast milk odor and rose damascena aroma have a similar effect in reducing the pain of neonates. Thus, according to the conditions, each of these methods can be used.
Clinical trial registry: IRCT20150713023190N11

 

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Background & Aim: Pain and inflammation caused by needle insertion into the fistula is a common problem in hemodialysis patients. The aim of this study was to evaluate the effect of topical application of Rosemary essential oil on inflammation and pain severity caused by needle insertion into arteriovenous fistula in patients undergoing chronic hemodialysis.
Methods & Materials: In this clinical trial, 60 hemodialysis patients from the hemodialysis ward of Golestan hospital and Imam Khomeini hospital in Ahvaz were randomly assigned to two groups using block randomization. The intervention group received rosemary essential oil, while the control group received distilled water applied to the needle insertion site 5 minutes before each hemodialysis session. Pain severity was assessed using the VAS scale and inflammation severity was determined using the Phlebitis checklist at baseline and during six sessions. Data were analyzed using t-test, chi-square test and repeated measures analysis of variance (ANOVA) on SPSS software version 22.
Results: The results showed that the mean score for pain increased in the control group from 5.13±1.74  to 5.93±1.67, while it decreased in the intervention group from 5.83±1.53 to 3.77±1.43 (P=0.003). Additionally, the mean score for inflammation increased during the sessions in the control group, ranging from 1.27±1.20 to 2.07±1.08. However, in the intervention group, the mean score for inflammation decreased from 2.57±1.92 to 1.33±1.44. Nevertheless, this difference was found to be statistically insignificant (P=0.267).
Conclusion: The findings of the present study showed that the topical application of rosemary essential oil had a significant effect on reducing pain resulting from needling. However, its effect on reducing the severity of arteriovenous fistula inflammation in patients undergoing hemodialysis was not statistically significant. Based on these results, it is recommended to provide training to nursing staff and hemodialysis patients regarding the use of rosemary essential oil as a means to alleviate pain experienced during the procedure. Further research is required to investigate its potential for reducing the severity of fistula inflammation.
Clinical trial registry: IRCT2019102804526N1

 

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Background & Aim: Patients undergoing hemodialysis commonly experience discomfort due to the insertion of needles into their arteriovenous fistula. The aim of the study was to compare the effect of EMLA ointment and lidocaine spray, along with the use of rhythmic breathing on the intensity of pain caused by the insertion of needles in the arteriovenous fistula among hemodialysis patients.
Methods & Materials: This study was a randomized clinical trial conducted on a total of 80 patients who were referred to Imam Khomeini and Golestan hospitals in Ahvaz in 2022. The numerical pain measurement scale was used as the data collection tool. The participants were selected using the convenience sampling method and then randomly allocated into two groups. In the EMLA ointment group (n=39), a total of 2 grams of EMLA ointment was applied to the target area 60 minutes before the hemodialysis procedure. In the lidocaine spray group with rhythmic breathing (n=41), 2 puffs of lidocaine spray were administered along with rhythmic breathing 5 minutes prior to needle insertion. The pain intensity was then measured and recorded. The collected data was analyzed using descriptive and inferential statistics in SPSS version 20, with a significance level set at 0.05.
Results: The group receiving EMLA ointment and the group receiving lidocaine spray, with rhythmic breathing had mean pain scores of 1.95±1.09 and 2.12±1.10, respectively. Although the mean pain score in the EMLA ointment group was lower than that in the lidocaine spray group with rhythmic breathing, the difference was not statistically significant (P=0.479).
Conclusion: The findings of this study indicate that both EMLA ointment and lidocaine spray, along with the use of rhythmic breathing, have comparable efficacy in reducing pain among hemodialysis patients. Therefore, considering the patient's condition, the utilization of either of these methods is recommended.
Clinical trial registry: IRCT20220512054826N1